Moraes Fabio Ynoe, Taunk Neil K, Marta Gustavo Nader, Suh John H, Yamada Yoshiya
Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Oncologist. 2016 Feb;21(2):244-51. doi: 10.1634/theoncologist.2015-0293. Epub 2016 Jan 13.
Brain metastases are the most common intracranial malignancy. Many approaches, including radiation therapy, surgery, and cytotoxic chemotherapy, have been used to treat patients with brain metastases depending on the patient's disease burden and symptoms. However, stereotactic surgery (SRS) has revolutionized local treatment of brain metastases. Likewise, targeted therapies, including small-molecule inhibitors and monoclonal antibodies that target cancer cell metabolism or angiogenesis, have transformed managing systemic disease. Prospective data on combining these treatments for synergistic effect are limited, but early data show favorable safety and efficacy profiles. The combination of SRS and targeted therapy will further individualize treatment, potentially obviating the need for cytotoxic chemotherapy or whole-brain radiation. There is a great need to pursue research into these exciting modalities and novel combinations to further improve the treatment of patients with brain metastases. This article discusses reported and ongoing clinical trials assessing the safety and efficacy of targeted therapy during SRS.
Treatment of patients with brain metastases requires a multidisciplinary approach. Stereotactic radiosurgery is increasingly used in the upfront setting to treat new brain metastasis. Targeted therapies have revolutionized systemic treatment of many malignancies and may sometimes be used as initial treatment in metastatic patients. There is sparse literature regarding safety and efficacy of combining these two treatment modalities. This article summarizes the supporting literature and highlights ongoing clinical trials in combining radiosurgery with targeted therapy.
脑转移瘤是最常见的颅内恶性肿瘤。根据患者的疾病负担和症状，包括放射治疗、手术和细胞毒性化疗在内的多种方法已被用于治疗脑转移瘤患者。然而，立体定向手术（SRS）彻底改变了脑转移瘤的局部治疗。同样，靶向治疗，包括针对癌细胞代谢或血管生成的小分子抑制剂和单克隆抗体，已经改变了全身性疾病的管理。关于联合这些治疗以产生协同效应的前瞻性数据有限，但早期数据显示出良好的安全性和疗效。SRS与靶向治疗的联合将进一步实现个体化治疗，可能无需进行细胞毒性化疗或全脑放疗。迫切需要对这些令人兴奋的治疗方式和新型联合治疗进行研究，以进一步改善脑转移瘤患者的治疗。本文讨论了已报道的和正在进行的评估SRS期间靶向治疗安全性和疗效的临床试验。
脑转移瘤患者的治疗需要多学科方法。立体定向放射外科越来越多地用于初始治疗新的脑转移瘤。靶向治疗已经彻底改变了许多恶性肿瘤的全身性治疗，有时可作为转移性患者的初始治疗。关于联合这两种治疗方式的安全性和疗效的文献很少。本文总结了相关支持性文献，并重点介绍了正在进行的将放射外科与靶向治疗联合应用的临床试验。
